硬化蛋白对骨代谢作用机制的研究进展

摘要：硬化蛋白（sclerostin,Scl）在骨代谢中发挥重要作用,大量动物实验及临床试验证实抑制硬化蛋白能改善骨结构、增加骨密度。硬化蛋白单克隆抗体Romosozumab(ROMO)已在美国和加拿大批准上市,是目前唯一一个兼具促进骨形成与抑制骨吸收双重作用的抗骨质疏松药物,但其不良反应与治疗期间表现的时间依赖性是目前存在的两大问题。因此,期待可以通过硬化蛋白研发出治疗效果更好、不良反应更少的新型抗骨质疏松症药物。因此,笔者介绍了目前对sclerotin的结构、表达及作用机制的认识,深入探讨了其发挥作用的分子靶点,以期能为未来药物研究提供新方向。还综述了硬化蛋白对骨骼系统中不同细胞的具体作用,分别叙述了其在破骨细胞（osteoclast,OC）、成骨细胞(osteoblast,OB)以及骨髓脂肪细胞的作用,并提出了未来应着力研究的方向。     

骨硬化蛋白与 DKK1 蛋白在慢性肾脏病 - 矿物质骨代谢紊乱中的研究进展

慢性肾脏病-矿物质骨代谢紊乱(chronic kidney disease-mineral and bone disorder, CKD-MBD)是慢性肾脏病(chronic kidney disease, CKD)患者的常见并发症,对其发病机制的研究目前认为主要与钙磷代谢异常以及甲状旁腺素(parathyroid hormone, PTH)、维生素D有关,但这些标记物一般在CKD的后期才出现明显改变。国内外实验研究表明,骨硬化蛋白(Sclerostin)与DKK-1蛋白作为Wnt信号通路的抑制剂参与了CKD-MBD的发病过程,对CKD-MBD的发病机制及诊疗有着重要意义。因此本文从骨硬化蛋白与DKK1蛋白着手对其在CKD-MBD中的作用及意义做一综述,以期对CKD-MBD的发病机制有更深的了解并为其治疗提供新的思路与方法。     

血液透析对患者血清碱性磷酸酶、骨硬化蛋白与骨代谢的影响

目的血液透析对患者血清碱性磷酸酶(ALP)、骨硬化蛋白(SOST)与骨代谢等指标的影响。方法选取本院2016年1月至2019年1月期间收治的血液透析患者116例为研究对象纳入观察组,另选同期在本院进行体检的50例健康受试者为对照组。采用酶联免疫吸附试验法对两组患者入院时的ALP、SOST、骨代谢指标:血清骨钙素(OC)、β胶原蛋白(β-CTX)、I型前胶原氨基末端前肽(PINP)指标水平,并进行组间对比。对观察组患者进行维持性的血液透析治疗,并检测比较在患者透析治疗前、透析治疗1、6、12个月的各项指标水平。采用Pearson检验对观察组患者的ALP、SOST与骨代谢指标的相关性进行分析。结果与对照组比较,观察组患者血液透析治疗前ALP、SOST、OC、β-CTX、PINP等指标均低于对照组受试者各项指标水平,组间比较差异有统计学意义(P<0.05)。观察组患者中随着透析治疗时间的延长,患者的ALP、SOST、OC、β-CTX、PINP等指标水平均明显上升,各时间点间比较差异有统计学意义(P<0.05)。经Pearson检验分析,血液透析患者的ALP、SOST与骨代谢指标OC、β-CTX、PINP呈正相关性。结论血液透析患体内的ALP、SOST、骨代谢指标均呈现异常降低,经持续性血液透析治疗患者的ALP、SOST、骨代谢指标均有改善,且ALP、SOST与骨代谢指标OC、β-CTX、PINP呈正相关性。     

骨硬化蛋白在慢性肾脏病血管钙化中的研究进展

骨硬化蛋白作为骨-血管轴之间的重要信使,在血管钙化发生发展中起着关键性作用,但其机制较为复杂。目前研究证明,骨硬化蛋白是一种骨细胞特异性糖蛋白,被认为是一种有效的骨形成抑制剂;通过抑制Wnt/β-连环蛋白信号传导激活所需的特定的共同受体而发挥其生物学效应。血清骨硬化蛋白水平可能反映了骨代谢,并且可能用作终末期肾病(ESRD)患者中低转换性骨疾病和肾性骨营养不良的标志物。然而,骨硬化蛋白与血管钙化的相互作用和慢性肾脏病(CKD)患者的临床预后尚不清楚。尽管如此,抗硬化蛋白抗体可能是一种新的治疗方法。本文旨在了解骨硬化蛋白的基本结构及其生物学活性,同时对其与慢性肾脏病及血管钙化的关系做一综述,并提出抗硬化蛋白抗体治疗在CKD患者中的应用。     

老年人血清骨硬化蛋白与冠心病及骨质疏松的相关性研究

目的探讨老年人血清骨硬化蛋白水平与冠心病及骨质疏松的相关性。方法入选重庆医科大学附属第二医院老年心血管科2014年10月至2015年10月因胸痛待查入院行冠状动脉造影的老年患者313例,其中诊断为冠心病的患者163例,非冠心病患者150例,取术前空腹静脉血用ELISA法测定血清骨硬化蛋白水平,同时测定骨密度及血脂、骨转换标志物等生化指标。采用多因素logistic回归模型分析骨硬化蛋白水平与冠心病发生的相关性,用多元线性回归分析影响骨硬化蛋白水平的相关因素。结果 (1)老年冠心病组骨硬化蛋白水平显著低于非冠心病组[(178.035±0.636)pg/m Lvs(180.576±0.608)pg/m L,P0.05];(2)多因素logistic回归提示老年患者骨硬化蛋白与冠心病发生负相关(OR=0.865,P=0.018),其中骨质疏松患者骨硬化蛋白水平升高可降低罹患冠心病的风险(OR=0.767,P=0.007),非骨质疏松患者骨硬化蛋白与冠心病无相关性(P0.05);(3)多元线性回归提示骨硬化蛋白水平与腰椎骨密度(β=0.224,P0.05)、I型胶原氨基端延长肽(β=0.161,P0.05)、年龄(β=-0.162,P0.05)显著相关。结论血清骨硬化蛋白与老年患者尤其是合并骨质疏松的老年患者冠心病发生密切相关,并可能在骨-血管轴中发挥信使作用。     

成人成骨细胞骨保护蛋白的表达与年龄关系的研究

目的探讨成人成骨细胞骨保护蛋白(OPG)的表达与年龄变化的相关性.方法体外分离培养12例成人成骨细胞.年龄39～74岁,大于60岁以上和小于60岁以下者各6例.采用逆转录-聚合酶链方法(RT-PCR)检测不同年龄段OPG mRNA的表达.结果大于60岁以上组OPG mRNA表达的相对含量为0.28±0.10,小于60岁以下组为0.49±0 14,其差异有显著性(P＜0.05).结论成骨细胞分泌的OPG随年龄的增长而逐渐减少,有可能是增龄性骨丢失的重要原因.     

硬化蛋白抗体和跑台运动对大鼠骨代谢的影响

目的通过对糖皮质激素诱导骨质疏松大鼠模型进行硬化蛋白和跑台运动的干预,研究硬化蛋白抗体和跑台运动对大鼠骨代谢的影响。方法雄性Wistar大鼠饲养到19周后,分为5组:C组(正常对照组)、M组(甲强龙对照组)、M+E组(甲强龙+运动组)、M+S组(甲强龙+硬化蛋白抗体组)、M+E+S组(甲强龙+运动+硬化蛋白抗体组)。结果 (1)注射甲强龙可以提高脂肪体重和骨细胞凋亡水平,降低全身和股骨骨矿物质含量,降低股骨骨密度和骨陷窝率,且伴随着股骨远端的骨小梁骨量的下降。(2)单纯性的运动可以提高骨量、骨陷窝率,同时可以降低脂肪体重、骨吸收标志物NTx和骨细胞凋亡水平,但运动不会影响骨矿物质含量和皮层骨参数结构。(3)单纯性的注射硬化蛋白抗体能增加骨形成标志物骨钙素(osteocalcin,OC),防止甲强龙对骨质量的不良影响,进而提高骨含量、骨密度以及骨体积百分比。硬化蛋白抗体可以增加远端和中段部分的皮质骨参数,防止骨陷窝率下降和因甲强龙诱导产生的骨细胞凋亡水平上升。(4)运动和硬化蛋白交互作用时,可以提高骨密度、皮质骨参数,促进骨形成抑制细胞凋亡的发生。结论单纯性的Scl-Ab注射方案可以预防糖皮质激素治疗对骨量的不良影响,显著提高皮质骨骨量和骨强度。单纯性的跑台运动方案可以降低脂肪含量,并在不影响皮质骨的情况下防止骨小梁丢失。运动与硬化蛋白之间表现出良好的协同作用,对治疗糖皮质激素诱导骨质疏松症具有积极作用。     

骨硬化蛋白和dkk1与2型糖尿病患者骨密度相关性研究

目的探讨骨硬化蛋白和dkk1与2型糖尿病患者骨密度相关性。方法这项横断面研究包括190名患有2型糖尿病的住院患者。我们根据不同的BMD水平将患者分为三组(即正常骨密度组,骨量减少组和骨质疏松组),并测量血清中骨硬化蛋白、dkk1、25-羟基维生素D 3(25OHD3)的水平,每组的骨转换标志物和其他生化数据。结果在骨质疏松症组中发现血清骨硬化蛋白和dkk1水平显著增加,即使分别考虑男性和女性群组。回归分析表明,在调整年龄、性别和25OHD3后,血清硬化蛋白水平与骨质减少和骨质疏松症存在独立相关。BMD与血清骨硬化蛋白和dkk1水平呈负相关,与25OHD3呈正相关。此外,年龄、糖化血红蛋白和血清骨硬化蛋白水平是1型前胶原氨基末端前肽(N-propeptide of type 1 collagen,P1NP)的预测因子,血清dkk1水平是1型胶原交联羧基末端肽(C-terminal crosslinking telopeptides of type 1 collagen,1CTP)的唯一预测因子。结论骨硬化蛋白和dkk1水平随着骨质疏松症2型糖尿病患者BMD的降低而增加。     

骨硬化蛋白单克隆抗体对于有去卵巢大鼠骨折愈合影响的实验研究

目的探索骨硬化蛋白单克隆抗体(Scl-Ab)对去势大鼠股骨干骨折愈合影响的实验研究。方法 30只健康雌性SD大鼠随机行假手术(Sham,n=5)和切除双侧卵巢(OVX,n=25)手术12w后每组各取5只大鼠处死取股骨行双能X线仪检测确保骨质疏松的建立,随后OVX组大鼠建立左侧股骨干中段骨折模型随机的分成2组:OVX组及骨硬化蛋白单克隆抗体治疗(Scl-Ab)组。术后第1天Scl-Ab组开始给予药物治疗:Scl-Ab皮下注射(剂量25 mg/kg,每周2次)直至8 w,8 w时所有大鼠处死取股骨行Micro-CT、硬组织切片检测及HE组织切片检测。结果 Micro-CT结果显示:Scl-Ab组和OVX组相比,骨折端有较多的新生骨形成,且有较高BV/TV、Tb.Th、Tb.N和较低的Tb.Sp值,比较有明显的统计学意义。HE结果表明Scl-Ab组骨折端有更多的骨痂形成,且骨痂更加成熟。硬组织切片观察结果表明:Scl-Ab组骨折端骨痂矿化速度更快,和OVX组表明有统计学意义。结论 Scl-Ab通过增加骨折端骨量及促进骨组织矿化来治疗去卵巢大鼠股骨中段骨折的愈合。     

骨形成蛋白与骨疾患关系的研究进展

目的：了解骨形成蛋白（ＢＭＰ）与机体骨疾患者发生发展的关系。方法：综述了近五年来ＢＭ与骨疾患关系的研究进展。结果：Ｂ屿骨发育异常、遗传性骨疾病、某些骨 异位骨化等有着直接或间接的关系。结论：搞清ＢＭＰ与机体骨疾患的关系。有助于进一步了解疾病的发病机制、病程进展和预后,为选择合适的治疗方法提供指导。     

中老年2型糖尿病患者肌少症相关因素研究

目的通过研究中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者肌少症(Sarcopenia)发生的危险因素,为预防和治疗肌少症提供思路。方法收集2018年5~11月于郑州大学第一附属医院内分泌科住院的289例中老年T2DM患者作为研究对象,以同期该院57名正常体检人群作为对照组,比较两组患者一般资料、血生化、HbA1c、肌力等指标的差异及两组肌少症的检出率。对两定量资料进行Pearson相关分析及Logistic回归分析,分析肌少症发生的危险因素。结果T2DM组中肌少症的检出率(22.83%)大于正常对照组(12.28%)(P<0.05)。T2DM组中,全身骨骼肌肌肉含量与体重、体质量指数(body mass index,BMI)、全髋部骨密度、腹部脂肪面积、25(OH)D3含量呈正相关,与空腹血糖、糖尿病病程呈负相关。低BMI、低全髋部骨密度、低25(OH)D3、长糖尿病病程是肌少症发生的危险因素。结论2型糖尿病患者是肌少症发生的危险人群,针对T2DM患者发生肌少症的相关危险因素采取干预措施,可减少跌倒、骨折、致残、致死事件的发生。     

呼和浩特市社区居住中老年人群身体成分分析与骨折风险性的关系

目的通过身体成分分析结果研究其与骨折风险性的关系。方法选取在呼和浩特市社区居住的中老年男女750名,其中男性183名,女性567名,年龄40～90岁。采用双能X线骨密度仪(DXA)进行身体成分和骨密度测定,通过骨折风险调查问卷进一步分析骨折风险性。结果调查人群平均年龄为66岁,女性体质量指数(bnoe mass index,BMI)为25. 7,男性BMI为28. 2;女性股骨颈骨密度为0. 62 g/cm~2,男性为0. 63 g/cm~2;女性未来10年主要部位的骨折风险为5. 9,男性为3. 0;女性未来10年髋部骨折的风险为2. 2,男性为1. 1;女性全身脂肪百分比为36. 8%,男性全身脂肪百分比为36. 4%,两组相比男性瘦组织量高于女性,脂肪百分比小于女性;女性主要部位的骨折与年龄、全身脂肪百分比相关,与股骨颈骨密度、全身瘦组织量与四肢瘦组织量、瘦组织指数呈负相关;男性与女性髋部骨折与年龄呈正相关,与股骨颈骨密度、全身瘦组织量、四肢瘦组织量呈负相关,有统计学意义。结论对身体成分的分析有助于预测骨折风险,分析社区居住老年人群身体成分指标的特点并调查相关因素,对骨折预防和治疗有着重大意义。     

老年人体质量指数与骨密度的关系

目的 探讨老年人营养代谢状态(体质量指数)与髋部骨密度(bone mineral density, BMD)的关系。方法 收集2019年1月至2021年6月于福建医科大学附属泉州第一医院就诊的老年女性骨质疏松症患者430例。记录患者的年龄、身高、体重、尿酸、肌酐、肾小球滤过率(GFR)、髋部BMD、甲状旁腺素(PTH)、N端骨钙素(N-Osrteoc)、I型原胶原N端前肽(PINP)、25羟基维生素D3 (25-OH-D3)。各指标相关性检验采用 Pearson相关性检验。结果 不同年龄组的BMD、GFR之间有统计学差异,并呈负相关,不同年龄组的体质量指数（body mass index, BMI)、尿酸氮、肌酐、尿酸、PTH、N-Osrteoc、PINP比较差异无统计学意义,与25-OH-D3比较差异有统计学意义并呈正相关。不同尿酸组内骨代谢标志物比较差异无显著性,各组间BMI、BMD、尿酸氮、肌酐比较差异有显著性并呈正相关,GRF比较差异有显著性并呈负相关;不同骨密度组之间BMI、尿酸氮、肌酐、尿酸、GRF比较差异有显著性,并与BMI、尿酸氮、肌酐、尿酸呈正相关,与GRF呈负相关,各组骨代谢标志物比较差异无显著性。结论 BMI会引起体内尿酸的改变,保持一定量的BMI及尿酸对于老年女性骨密度的维持有积极作用,这种作用与体内激素变化引起的骨代谢变化不相关。     

骨硬化蛋白与维持性血液透析患者冠状动脉钙化的关系

Objective To evaluate the potential association of serum sclerostin with the development of coronary artery calcifications(CAC)in maintenance hemodialysis (MHD) patients. Methods Ninety-two patients who were on MHD between Jan 2014 and Jan 2015 in the dialysis center were enrolled prospectively. Serum sclerostin was tested. CAC was measured by multi-slice computed tomography (MSCT) scanning, and the CAC score (CACs) was calculated. Logistic regression analysis was used to determine the risk factor of CAC in MHD patients. The diagnostic value of serum sclerostin for CAC was assessed using receiver operator characteristic curve (ROC). Results CAC (Agatston score>100) was present in 65.2% (60/92) patients, the median CAC score was 446 (26, 1 000). The median of serum sclerostin levels was 37.05 (29.99, 49.04) ng/L. The serum sclerostin levels were significantly elevated in the group of CACs＞400 compared to that in the group of CACs＜100 [40.71(36.69, 74.21) ng/L vs 28.16 (25.27, 33.64) ng/L, P＜0.05]. Multivariate logistic regression analysis showed that serum sclerostin level was independent risk factor for CAC (OR=1.292, 95%CI 1.017-1.641, P＜0.05). The area under the ROC curve (AUC) of serum sclerostin for CAC was 0.846 (95%CI 0.717-0.975, P=0.001), sensitivity was 0.826, and specificity was 0.769 for a cutoff value of 35.165 ng/L. Conclusions Serum sclerostin level is associated with CAC. Serum sclerostin level may have a diagnostic value for CAC in MHD patients.     

健康男性的胰岛素抵抗指数、肥胖、血清PSA水平间的关系

本研究旨在确定血清PSA水平低于4ngmL^-1的健康男性的胰岛素抵抗指数、肥胖和血清前列腺特异性抗原（PSA）水平之间的关系。调查对象为韩国水力原子力株式会社的11827名健康男性职员,在2003年1月到2008年12月间接受了体检,体检项目包括空腹血糖水平、空腹胰岛素水平和血清PSA水平。用稳态模式评估法（HOMA;[空腹血糖水平×空腹胰岛素水平]／22．5）和定量胰岛素敏感性检验指数（QUICKI;1／[10g（空腹胰岛素水平）＋log（空腹血糖水平）]）测定胰岛素抵抗指数。协方差分析（ANOVA）和Duncan’s多重比较试验显示,随着用HOMA和OuICKI测定的胰岛素抵抗指数四分位的上升,年龄标化体重指数（BMI）也显著增加（P〈0．001）。多变量线性回归分析表明,相对于血清PSA水平,年龄、BMI、以及用HOMA或QUICKI测得的胰岛素抵抗指数都是显著的独立变量（P〈0．001）。本研究说明胰岛素抵抗指数和BMI都是血清PSA水平的独立变量,在健康男性体内,两者都与血清PSA水平呈负相关,两者之间呈正相关。     

Age, body mass index, current smoking history, and serum insulin-like growth factor-I levels associated with bone mineral density in middle-aged Korean men

Osteoporosis is a growing health problem in women and in men. This cross-sectional study examined the association of anthropometric, lifestyle, and hormonal factors with bone mineral density (BMD) in 152 healthy Korean middle-aged men. Smoking habits and alcohol consumption were assessed by interview. Serum testosterone and insulin-like growth factor-I (IGF-I) levels were measured by radioimmunoassay, and serum growth hormone (GH) levels were measured by immunoradiometric assay. GH stimulation tests were performed after the ingestion of 500mg of L-dopa. BMD was measured at the lumbar spine and at the femoral neck by dual-energy X-ray absorptiometry. Of the middle-aged men, 3.9% were osteoporotic and 28.3% were osteopenic at the lumbar spine site, and 5.9% were osteoporotic and 45.4% were osteopenic at the femoral neck site. Lumbar spine BMD correlated significantly with body mass index (BMI), and femoral neck BMD correlated significantly with age, BMI, and serum IGF-I levels. The lowest quartile group for serum IGF-I levels showed the lowest femoral neck BMD. Osteoporotic men by lumbar spine BMD showed significant differences from the normal BMD group in terms of BMI and smoking habits. Also, osteoporotic men by femoral neck BMD were significantly different for mean age, BMI, and serum IGF-I levels compared with the normal BMD group. On multiple regression analysis, BMI was found to be the only independent predictor of lumbar spine BMD, whereas both BMI and serum IGF-I levels were found to be the independent predictors of femoral neck BMD. Overall, 28.3%–45.4% of middle-aged Korean men were osteopenic. We suggest that higher age, a lower BMI, current smoking history, and lower serum IGF-I levels are risk factors for lower BMD in middle-aged Korean men; however, serum testosterone levels and GH secretory capacity were not found to be correlated with BMD.     

Relationship of abdominal pressure and body mass index in men with LUTS

AIMS: In the development of a non-invasive method for estimating isovolumetric intravesical pressure (pves,isv) we looked for a relationship between intra-abdominal pressure (pabd) and general build, expressed as body mass index (BMI) in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: In 100 consecutive male patients undergoing an invasive pressure flow study (PFS) the pabd was recorded continuously during filling and voiding. The magnitude at four set points was measured: before filling, after filling, during voiding and at the end of voiding. Patients' weight (kg) and height (m) were also recorded and their BMI (weight/height(2)) was calculated. RESULTS: During the fill/void cycle pabd increased during bladder filling from 37 +/- 7 cm H2O (mean +/- SD) to 38 +/- 8 cm H2O, fell during voiding to 35 +/- 9 cm H2O before increasing to 36 +/- 8 cm H2O at the end of voiding. There was a clear relationship between the individual values of pabd and BMI (correlation co-efficient = 0.52) and to a lesser extent weight (correlation co-efficient = 0.42). The relationship with BMI was clarified by separating the subjects into groups of normal, overweight and obese. CONCLUSIONS: A clear relationship between BMI and pabd was demonstrated, but because of the difficulties in quantifying it for an individual, it is impractical to apply an adjustment to non-invasive estimates of pves,isv.     

预后营养指数对老年骨质疏松症患者髋关节置换术后风险预测及影响因素分析

目的分析预后营养指数(prognostic nutritional index,PNI)与老年骨质疏松(osteoporosis,OP)症患者髋关节置换术后的风险预测及影响因素,探讨PNI作为老年骨质疏松症患者髋关节置换术后风险及预后指标的作用价值。方法回顾性分析本院2016年5月至2018年12月收治的老年OP行髋关节置换术264例患者的临床资料,根据PNI指数分为PNI≥45(112例)和PNI45(152例),通过单因素和多因素分析评价老年骨质疏松症患者髋关节置换术后影响因素,并分析其预测价值。结果 PNI45的分组患者比PNI≥45分组患者具有更高的年龄、体质量指数(body mass index,BMI)、高术后并发症、低骨密度、高血清PTH及BLAP含量、低Harris评分,差异具有统计学意义(P均0.05)。但其他指数和指标在两组间对比,差异无统计学意义(P均0.05)。不同PNI分组患者的营养免疫相关血液学指标(HGB、TP、ALB、LYMPH、RBC、PALB)及BMI、Harris评分情况在不同时间段进行纵向变化比较,组内及组间差异分别具有统计学意义(P0.05,P0.01)。多因素分析结果显示,PNI(HR=1.26,95%CI:0.89～2.01,P0.001,标准化偏回归系数=0.055)的贡献度最高,是预测术后的独立危险因素。且Kappa系数提示,PNI与Harris筛查评定结果具有一致性(P0.001)。结论 PNI是老年骨质疏松症患者髋关节置换术后独立影响因素,对老年骨质疏松症患者髋关节置换术后风险预测及影响因素分析具有重要意义。     

Prevalence and risk factors of undetected proteinuria in an elderly South-East Asian population

BACKGROUND: Urinalysis is not a standard component of health screening in the elderly population. OBJECTIVE: We investigated the prevalence and risk factors of undetected renal disease as defined by proteinuria (PR) in an elderly South-East Asian population. METHOD: There were 19,848 participants of age >or=65 years in National Kidney Foundation's Nationwide Screening programme at Singapore. Mean age was 70.6 +/- 5.3 years. After excluding the 1.1% who had pre-existing renal disease, 8.5% were identified to have previously undetected PR defined as >or=1+ protein on urine dipstick analysis. Multivariate regression revealed that male gender (OR = 1.2, reference category (Ref): female), known diabetes (odds ratio (OR) = 2.28; P < 0.0001), hypertension (OR = 1.62; P = 0.0001), presence of elevated blood pressure (BP) (>or=120/90 mmHg) on screening (OR = 1.38, 1.89, 3.45 for mild, moderate and severe BP, respectively, all P < 0.0001), elevated body mass index (BMI) (OR = 1.3 for BMI >or=23 vs BMI < 23 kg/m(2)), and smoking (OR = 1.2, ref: non-smokers) were significantly associated with PR. Finally, a progressive increase in OR for PR was observed with stepwise increase in age (years) (OR for 67-68.9: 1.2, P = 0.025; 69-72.9, 1.49, P = 0.49; >or=73: 1.56, P < 0.0001, Ref: 65-66.9 years). CONCLUSION: We conclude that there is high prevalence of previously undetected proteinuria in elderly South-East Asians. Because proteinuria is a risk factor for cardiovascular disease, our findings support inclusion of urinalysis in routine health screening for this population.     

Relationship between visceral adiposity index and male infertility

The visceral adiposity index (VAI), which is calculated by using parameters such as body mass index (BMI), waist circumference, triglyceride, and high-density lipoprotein cholesterol, has been reported to be associated with visceral fat distribution and increased cardiometabolic risk. We aimed to investigate the relationship between the VAI and hormone profiles as well as semen analysis in male infertility. This retrospective study included 278 adult men that were admitted to the urology and endocrine outpatient clinics. Patient data were reviewed, and outcomes were recorded. BMI and VAI were calculated and noted separately. BMI was negatively correlated with serum testosterone and testosterone/ estradiol ratio (T/E2) (p < .05 for all). There was no significant relationship between BMI and semen parameters (p > .05 for all). However, there was a significant negative correlation between VAI and semen parameters, total serum testosterone and T/E2 (p < .05 for all). Furthermore, VAI was independently associated with the total motility score. The increase in visceral adiposity that can be demonstrated by VAI may adversely affect male fertility due to its metabolic and hormonal effects. Since infertility occurs as a result of different metabolic conditions, the underlying mechanisms can be better understood from a multidisciplinary perspective.